{template 'header'}
<link type="text/css" rel="stylesheet" href="../addons/eso_sale/recouse/credit/base.css" />
<link type="text/css" rel="stylesheet" href="../addons/eso_sale/recouse/credit/style.css?v=1" />
<script type="text/javascript" src="../addons/eso_sale/recouse/credit/script.js"></script>
<style type="text/css">
    body { background-repeat: repeat; }
</style>
<title>兑奖信息</title>
<section class="reserve">
    <!--content-->
    <section class="reserve_content">
        <!--title-->
        <p class="reserve_title"><span style="color:#fff">请认真填写以下信息</span></p>
        <!--tielt end-->
        <!--details-->
        <section class="reserve_details">
            {php foreach(explode("-",$award_info['title']) as $v) echo "<p>" . $v . "</p>"; }
        </section>
        <!--details end-->
        <!--data-->
        <section class="reserve_data">

            <form action="" method="post" data-ajax="false" onsubmit="return check(this)">
                <input name="id" type="hidden" id="id" value="{$award_list['award_id']}" />
                <input name="act" type="hidden"  value="module">
                <input name="name" type="hidden"   value="eso_sale">
                <input name="do" type="hidden"  value="credit">
                <input name="uniacid" type="hidden"  value="{$_W['uniacid']}">
                <section class="data_box">
                    <label class="data_box_l">真实姓名</label>
                    <span class="data_box_r"><input type="text" name="realname" value="{$profile['realname']}" placeholder="请输入您的真实姓名" class="txt" /></span>
                </section>
                <section class="data_box">
                    <label class="data_box_l">联系电话</label>
                    <span class="data_box_r"><input name="mobile" type="text" value="{$profile['mobile']}" placeholder="请输入您的手机" class="txt" /></span>
                </section>
                <section class="data_box">
                    <label class="data_box_l">邮寄地址</label>
                    <span class="data_box_r"><input name="residedist" type="text" value="{$profile['residedist']}" placeholder="请输入您的邮寄地址" class="txt" /></span>
                </section>

                <!--btn-->
                <section class="reserve_btn_box">
                    <input type="submit" value="提交登记" class="reserve_btn" />
                </section>
                <!--btn end-->
                <input type="hidden" name="token" value="{$_W['token']}" />
            </form>
        </section>
        <!--data end-->
    </section>
    <!--content end-->
</section>

<script type="text/javascript">
    function check(form) {
        if (!form['realname'].value) {
            alert('请输入您的真实姓名！');
            return false;
        }
        if (!form['mobile'].value) {
            alert('请输入您的手机号码！');
            return false;
        }
        if (!/^1[0-9]{10}/.test(form['mobile'].value)) {
            alert('请输入正确的手机号码！');
            return false;
        }
        if (!form['residedist'].value) {
            alert('请输入您的邮寄地址！');
            return false;
        }
        return true;
    }
</script>

{template 'footer'}
